Table 1. Global chromoblastomycosis working group strategy on global control of chromoblastomycosis.

Category	Actions required
Technical progress
Scientific understanding	• Better understanding of the role of melanin, muriform cells, and chitin in fungal virulence • Improve research on the impact of climate change (e.g., global warming, severe weather events) on causative fungi distribution and incidence • Better understand natural history and reservoirs of chromoblastomycosis-causing fungi • Evaluate risk factors and prevalence of chromoblastomycosis complications
Diagnostics	• Improve access to microscopes and training for direct mycological examination • Determine performance and feasibility of low-cost, practical sample collection methods like vinyl adhesive tape • Develop late diagnostic strategies, when muriform bodies or culture cannot be obtained, to detect refractory or relapsing infection • Develop epidemiological cutoff values for common causative fungi • Improve antifungal susceptibility testing practices • Increase research support to increase whole genome sequencing in endemic areas
Effective intervention	• Develop standardized treatment guidelines • Develop novel antifungals with less drug–drug interactions, side effects, absorption issues, and longer dosing intervals • Investigate other triazole antifungals (e.g., voriconazole, posaconazole) as initial and for refractory treatment • Assess itraconazole combination therapy with other pharmaceuticals, including topical antifungals, and non-pharmaceuticals
Strategy and service delivery
Operational and normative guidance	• Develop comprehensive guidance on establishing chromoblastomycosis surveillance, prevention measures, and case management and control • Validate clinical staging system for chromoblastomycosis in different regions
Planning, governance, and program implantation	• Chromoblastomycosis activities should be incorporated into existing NTD infrastructure and programs
Monitoring and evaluation	• Develop global standardized case definitions and key surveillance and monitoring and evaluation indicators • Encourage countries to make chromoblastomycosis reportable nationally • Conduct precise mapping of causative fungi in endemic areas • Monitor for quality of life and disability burden
Access and logistics	• Improve sustainable access to both laboratory equipment and staining supplies • Increase continuity of access to itraconazole in rural and urban locations • Advocate for access or negotiated price to improve access to itraconazole
Health care infrastructure	• Strengthen primary health care for early detection, referrals, and follow-up care • Ensure access to health centers for wound management and WASH; integrate into skin NTD manual for wound management • Develop essential health care menu for integration into primary health care service essential care package
Enablers
Advocacy and funding	• Encourage Ministry of Health and health leaders to make chromoblastomycosis a reportable disease and develop a national control program in the NTD and health sector plan • Pilot itraconazole donation programs to evaluate outcomes
Collaboration and multisectoral action	• Integration into existing NTD infrastructure at global, national, and subnational levels • Engagement with WASH activities and programs to raise awareness of chromoblastomycosis and evaluate WASH’s role in prevention • Clinicians, researchers, government and public health officials, patients, and policy makers can stay engaged with chromoblastomycosis through the Global Chromoblastomycosis Working Group
Capacity and awareness building	• Integrate chromoblastomycosis conventional diagnostic training with pan-fungal and skin-NTD diagnostic training • Develop chromoblastomycosis training for various levels of health care and disseminate the OpenWHO online course more widely